Monthly Archives: February 2023

Sins of the Pfizer

It does not give me any pleasure to have to publish this article. I have used many Pfizer products over the years to the benefit of many of my patients, However, the article below is an eye-opener. Pfizer also make Lipitor, a cholesterol drug. I have critised the inappropriate prescribing of Statins over the years. Read my previous post ” on May the 26. (From the New York Times)

May 26

Posted by Dr Colin Holloway

Do You Really Need That Statin? This Expert Says No

Sins of the Pfizer

bySimon Elmer

25 February 2023 7:00 AM

In an interview with CNBC News in September 2020, Dr. Albert Bourla, the veterinarian Chief Executive Officer of Pfizer — the second largest pharmaceutical company in the world by revenue — said that anyone refusing to take the BioNTech vaccine will become “the weak link that will allow the virus to replicate”, and assured the public that “we will develop our product, develop our vaccine using the highest ethical standards”.

It was a dangerous claim to make, even for a CEO and investor making billions out of the experimental mRNA gene therapy product. Pfizer has a long history of paying out vast sums in out-of-court settlements to avoid not only claims in civil cases but also prosecution on criminal charges resulting from the fraudulent promotion, unapproved prescription and injury, including death, from use of its products. It has also offered millions in payments to doctors and scientists to prescribe, test, approve and recommend them to the public. So let’s have a look at what Dr. Albert Bourla means by Pfizer’s ‘ethical standards’.

  • In 1992, Pfizer agreed to pay between $165 million and $215 million to settle lawsuits arising from the fracturing of the Bjork-Shiley Convexo-Concave heart valve, which by 2012 has resulted in 663 deaths.
  • In 1996, Pfizer conducted an unapproved clinical trial on 200 Nigerian children with its experimental anti-meningitis drug, Trovafloxacin, without the consent of their parents and which led to the death of 11 children from kidney failure and left dozens more disabled. In 2011, Pfizer paid just $700,000 to four families who had lost a child and set up a $35 million fund for the disabled. This cover-up was the basis of the John Le Carré book and film The Constant Gardener.
  • In 2004, Pfizer’s subsidiary Warner-Lambert was fined $430 million to resolve criminal charges and civil liabilities for the fraudulent promotion of its epilepsy drug, Neurontin, paying doctors to prescribe it for uses not approved by the Food and Drug Administration.
  • In 2009, Pfizer spent $25.8 million lobbying Congressional lawmakers and federal agencies like the Department of Health and Human Services. Its expenditure on federal lobbying between 2006 and 2014 came to $89.89 million. In 2019 it spent $11 million lobbying the federal Government.
  • In 2009, Pfizer set a record for the largest health care fraud settlement and the largest criminal fine of any kind, paying $2.3 billion to avoid criminal and civil liability for fraudulently marketing its anti-inflammatory drug, Bextra, which had been refused approval by the FDA due to safety concerns.
  • In 2009, Pfizer paid $750 million to settle 35,000 claims that its diabetes drug, Rezulin, was responsible for 63 deaths and dozens of liver failures. In 1999, a senior epidemiologist at the Food and Drug Administration warned that Rezulin was “one of the most dangerous drugs on the market”.
  • In 2010, Pfizer was ordered to pay $142.1 million in damages for violating a federal anti-racketeering law by its fraudulent sale and marketing of Neurontin for uses not approved by the FDA, including for migraines and bi-polar disorder.
  • In 2010, Pfizer admitted that, in the last six months of 2009 alone, it had paid $20 million to 4,500 doctors in the U.S. for consulting and speaking on its behalf, and $15.3 million to 250 academic medical centres for clinical trials.
  • In 2012, Pfizer paid $45 million to settle charges of bribing doctors and other health-care professionals employed by foreign Governments in order to win business. The Chief of the Securities and Exchange Commission Enforcement Division’s Foreign Corrupt Practices Act Unit said: “Pfizer subsidiaries in several countries had bribery so entwined in their sales culture that they offered points and bonus programs to improperly reward foreign officials who proved to be their best customers.”
  • By 2012, Pfizer had paid $1.226 billion to settle claims by nearly 10,000 women that its hormone replacement therapy drug, Prempro, caused breast cancer.
  • In 2013, Pfizer agreed to pay $55 million to settle criminal charges of failing to warn patients and doctors about the risks of kidney disease, kidney injury, kidney failure and acute interstitial nephritis caused by its proton pump inhibitor, Protonix.
  • In 2013, Pfizer set aside $288 million to settle claims by 2,700 people that its smoking cessation drug, Chantix, caused suicidal thoughts and severe psychological disorders. The Food and Drug Administration subsequently determined that Chantix is probably associated with a higher risk of heart attack.
  • In 2013, Pfizer absolved itself of claims that its antidepressant, Effexor, caused congenital heart defects in the children of pregnant woman by arguing that the prescribing obstetrician was responsible for advising the patient about the medication’s use.
  • In 2014, Pfizer paid a further $325 million to settle a lawsuit brought by health-care benefit providers who claimed the company marketed its epilepsy drug, Neurontin, for purposes unapproved by the FDA.
  • In 2014, Pfizer paid $35 million to settle a law suit accusing its subsidiary of promoting the kidney transplant drug, Rapamune, for unapproved uses, including bribing doctors to prescribe it to patients.
  • In 2016, Pfizer was fined a record £84.2 million for overcharging the NHS for its rebranded and deregulated anti-epilepsy drug Phenytoin by 2,600% (from £2.83 to £67.50 a capsule), increasing the cost to U.K. taxpayers from £2 million in 2012 to about £50 million in 2013.
  • In May 2018, Pfizer still had 6,000 lawsuits pending against claims that its testosterone replacement therapy products cause strokes, heart attacks, pulmonary embolism and deep vein thrombosis, and were fraudulently marketed at healthy men for uses not approved by the FDA.
  • In June-August 2020, the U.S. Securities and Exchange Commission and the Department of Justice said they were looking at Pfizer’s activities in China and Russia under the Foreign Corrupt Practices Act, which forbids U.S. firms from bribing foreign officials.
  • In November 2021, the British Medical Journal revealed that the Ventavia Research Group had falsified data, unblinded patients, employed inadequately trained vaccinators, and was slow to follow up on adverse events reported in the phase 3 trial for Pfizer’s ‘vaccine’.
  • Since 2000, Pfizer has incurred $10.268 billion in penalties, including $5.637 billion for safety-related offences; $3.373 billion for unapproved promotion of medical products; $1.148 billion for government contract-related offences; $60 million under the Foreign Corrupt Practices Act; and $34.7 million for ‘kickbacks and bribery’.

Given this record of ongoing corruption and malpractice from, which only its enormous profits have saved it from criminal prosecution by means of out-of-court settlements, it seems extraordinary that Pfizer Inc. is still permitted to manufacture and sell any health-care products. Yet this is the pharmaceutical company we were asked by the U.K. Government, the Scientific Advisory Group for Emergencies, the Joint Committee on Vaccination and Immunisation, the U.K. Health Security Agency and the National Health Service to trust with the mass vaccination of 68 million people with a product that was rushed through clinical trials in seven months, employing experimental mRNA biotechnology whose clinical trials are not due to be completed until March 2023, for a disease with the infection fatality rate not much above seasonal influenza, which statistically is no threat to those under 50 years old, and for which there is no evidence that it prevents infection by the virus.

That was three years ago, during which the British people have paid with their freedoms, their health and their lives for believing the lies of their Government, their National Health Service and international pharmaceutical companies. Subsequent retractions by Pfizer, however, are an opportunity to revisit its claims in more detail.

On December 10th 2020, the U.S. Vaccines and Related Biological Products Advisory Committee met to evaluate the trial data on the efficacy and safety of Pfizer/BioNTech’s mRNA COVID-19 vaccine contained in the briefing document produced by Pfizer itself titled ‘Pfizer-BioNTech COVID-19 Vaccine (BNT162, PF-07302048) Vaccines and Related Biological Products Advisory Committee Briefing Document‘. It was on the basis of this evaluation that, on December 11th, the Food and Drug Administration (FDA) granted Emergency Use Authorisation to its mRNA gene therapy product. And given the subsequent debate about what Pfizer claimed its ‘vaccine’ would do, it might be useful to review the contents of this document.

The FDA’s Emergency Use Authorisation, which requires less data than standard approvals and is based on a lower standard of proof, was issued for a vaccine “intended to prevent Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2”. It was issue for prevention, therefore, not for reduction of the severity of symptoms, as was claimed when it became clear the gene therapy product did not prevent infection. Pfizer’s claim was that its product had a ‘vaccine efficacy’ of 95% protection against COVID-19 occurring after second days from injection with the second dose. In its clinical trials, a ‘case’ of COVID-19 was defined as a positive RT-PCR test for SARS-CoV-2 and the presence of at least one of the following symptoms: fever, cough, shortness of breath, chills, muscle pain, loss of taste or smell, sore throat, diarrhoea or vomiting. Nothing was said about asymptomatic ‘cases’ of COVID-19, or claimed about the ability of the gene therapy product to stop ‘asymptomatic transmission’ of the virus.

Pfizer’s benefit assessment was that its mRNA vaccine may be able to induce “herd immunity”, induces strong “immune responses”, and “confers strong protection against COVID-19”. This clearly indicates protection against both infection with the virus and the disease. Since transmission of a virus from person to person requires prior infection, Pfizer’s claim that its vaccine protects against infection, and the suggestion that sufficient injections will induce ‘herd immunity’, is also, by extension, a claim that it stops transmission from the injected.

The subsequent claim by Janine Small, Pfizer’s President of International Developed Markets, during her testimony before the European Union Parliament in October 2022, that Pfizer never tested whether its ‘vaccine’ stopped transmission appears, therefore, to rest on the myth of ‘asymptomatic transmission’. The implication of her statement was that Pfizer’s product only stops infection with SARS-CoV-2 and symptoms of COVID-19. However, the FDA’s Emergency Use Authorisation for Pfizer’s vaccine was based on prevention of both infection and disease. Pfizer’s claim is not evidence, as many afterwards claimed, for the lack of justification for making injection a condition of lifting lockdown or imposing vaccine passports, but rather an attempt to deny responsibility for the failure of its product (from which it has made $69 billion) to meet either of its claims.

An indication of just how unscientific was the FDA’s Emergency Use Authorisation of Pfizer’s vaccine is that it was granted on the basis of protection from infection and disease, while conceding there is no evidence that the vaccine “prevents transmission from person to person“. This is the way the ‘Science’ we mustn’t question or deny but blindly follow is conducted in what I call the global biosecurity state. Indeed, three years after it announced the pandemic in March 2020, the World Health Organisation can still only offer the following justifications for the four vaccines authorised for use in the U.K.

  • Pfizer/BioNTech: “There is modest vaccine impact on transmission.”
  • AstraZeneca/Oxford: “No substantive data are available related to impact of the vaccine on transmission or viral shedding.”
  • Moderna: “There is only modest impact on preventing mild infections and transmission.”
  • Novavax: “There is not currently sufficient evidence to date to evaluate the impact of the vaccine on transmission.” (See World Health Organisation, ‘COVID-19 advice for the public: Getting vaccinated’.)

Failure to offer protection against infection or transmission, however, are the least of the failings of Pfizer’s ‘vaccine’. As the evidence of the harms and deaths caused by this experimental gene therapy product injected into the U.K. public becomes too overwhelming for all but the Covid-faithful, the British press, the U.K. Parliament and our Government to ignore, there have been no end of doctors, nurses and medical professionals protesting they thought Pfizer’s biotechnology was ‘safe and effective’. But aren’t they trained to spot when something is going medically very wrong?

As of January 25th 2023, the Medicines and Healthcare Products Regulatory Agency, responsible for authorising the injection of the Pfizer/BioNTech vaccine into U.K. citizens, has received 180,005 reports of 517,779 adverse reactions to the injections, over 70% of which reports (127,405) have been classified as ‘serious’, including 884 deaths following injection. Including AstraZeneca’s viral-vector gene therapy product and Moderna’s mRNA gene therapy, the MHRA has received a total of 477,553 reports of 1,555,433 adverse reactions to the COVID-19 gene therapies, 74 per cent of which (355,052 reports) are categorised as ‘serious’, including 2,436 deaths following injection.

By the MHRA’s own estimation, only 10% of serious adverse reactions and 2-4% of non-serious reactions are reported, so the actual tally of injuries, autoimmune disease, reproductive and breast disorders, miscarriages and premature births, facial paralysis, blood clotting, amputations, myocarditis, pericarditis, heart attacks and deaths — all of which were recorded in Pfizer’s own analysis of post-authorisation adverse events as early as February 2021 — is far higher, undoubtedly many times higher. Indeed, this — and not the risible excuses with which the U.K. public has been fobbed off by the U.K. media — is likely a major cause of the huge increase in mortality in the U.K. since the ‘vaccine’ programme was implemented, contributing to the more than 60,000 excess deaths in 2022.

Given which, it is my contention that any medical professional that authorised or administered the injection of U.K. citizens with the Pfizer/BioNTech gene therapy product is at risk of being found guilty in a court of law for failure to give sufficient warning of adverse effects and obtain informed consent.

Simon Elmer is the author of two new volumes of articles on the U.K. biosecurity state, Virtue and Terror and The New Normal, which are available in hardback, paperback and as an ebook. This article is an extract from an article in Volume 2, ‘Bowling for Pfizer’. Please click on these links for the contents page and purchase options. On March 11th, to mark the third anniversary since the declaration of the pandemic by the World Health Organisation, he will be holding a book launch at the Star & Garter, 62 Poland Street, W1F 7NX, upstairs in the William Blake room from 6-8pm. Entry is free, with book signings, a reading and open-mic discussion.

Every Woman Can Benefit From This Pelvic Floor Workout

Every Woman Can Benefit From This Pelvic Floor Workout

It’s time to show these overlooked muscles more love.


By Danielle Friedman

The author has done regular pelvic floor exercises and relied on them to stay active since becoming pregnant with her first child in 2018.

  • Published Feb. 17, 2023Updated Feb. 20, 2023

The pelvic floor muscles may be the most important muscles you never target with a workout. Like a trampoline that sits at the base of your pelvis, these muscles not only contribute to overall core strength, they also hold multiple organs in place — including the bladder, bowel and, for some, the vagina and uterus — ensuring they work properly.

And yet, many people don’t even know the pelvic muscles exist, said Dr. Amy Park, the head of female pelvic medicine at the Cleveland Clinic — at least, not until they stop working properly. “There’s a general lack of awareness about the pelvic area,” said Dr. Park. “I educate women multiple times a day about the fact that we have pelvic floor muscles.”

They may not be visible like triceps or quads, she said, but they are vital for everything from basic bathroom functions to sexual health to sitting and standing — and they benefit from a well-rounded fitness program.

The pelvic floor is “just as important in your daily life as your Achilles is for running, because we use it for everything,” said Liz Miracle, the head of clinical quality and education at the pelvic floor physical therapy provider Origin.

A triptych illustration of the side view of the pelvis and the muscles that make up the pelvic floor.
The pelvic floor muscles, shown here from the side, run from the pubic bone in the front to the tailbone in the back of the pelvis. Like a trampoline or sling, they help to support the bladder, uterus and rectum (as shown here) and other organs, ensuring they work properly.Credit…Laura Edelbacher

Historically, talking about this region of the body, even with one’s physician, has felt off limits to many. Even the name for the pudendal nerve, which runs through the pelvic floor, comes from a Latin word that means “to be ashamed.”

This prudishness has led to years of unnecessary suffering, said Evelyn Hecht, a pelvic floor physical therapist in New York City who began practicing in the 1990s: Many conditions could be treated or avoided entirely if women felt freer to discuss their symptoms, or if the public were better informed about the pelvic floor. Instead, millions live with pain or discomfort.

Nearly one in three American women suffers from a pelvic floor disorder, most commonly in the form of urinary incontinence, bowel incontinence, pelvic pain, pelvic organ prolapse or some combination of the above. And this doesn’t just afflict women who have given birth: Studies suggest a significant percentage of women with pelvic floor disorders have never been pregnant.

When our pelvic floor is both strong and flexible, the muscles work together — or “co-contract” — with the core muscles to allow us to live our daily lives with ease and to stay active as we age, said Ms. Hecht, who now runs the digital pelvic health provider PelvicSense. The pelvic floor helps with balance and mobility during sports and exercise, too. “If I’m playing pickleball and I want to reach for a shot,” she said, “my pelvic floor is going to co-contract and stabilize my trunk.”

A triptych illustration of different views of the pelvis and the muscles that make up the pelvic floor.
The pelvic floor muscles, as seen from the side, from above and from the front. These muscles contribute to everything from basic bathroom functions to sexual health to our ability to sit and stand.Credit…Laura Edelbacher

Pelvic floor problems can be caused or exacerbated by anything that puts pressure on the muscles over time, leading them to tear or weaken — that includes running, dancing, heavy lifting without proper form, chronic constipation or even regular coughing, pregnancy and childbirth. Injuries can also arise when the muscles become too tight, which can be caused by regularly “holding it in” when you feel the urge to go to the bathroom, by overtraining the core or even by long-term stress and anxiety. (When stressed, many people reflexively clench these muscles.)

Recently, pelvic floor specialists have reported an uptick in disorders resulting from tight pelvic muscles — a trend they’ve called “pandemic pelvis” since the most common cause appears to be stress combined with too much sitting.

But pelvic floor problems aren’t inevitable. Many pelvic issues can be prevented or mitigated by regularly stretching and strengthening these muscles — and understanding how they function. Most of us could benefit from “a personal trainer for our pelvic floor,” said Dr. Lauren Streicher, medical director of Northwestern University’s Center for Sexual Medicine and Menopause.

Ms. Miracle — herself a physical therapist and a kind of personal trainer for the pelvis — recommended that all women in good pelvic health (those who aren’t currently suffering from a pelvic floor disorder or injury) incorporate six foundational exercises into their fitness routine, aiming to do them at least three times a week. The workout can be done any time and place you feel comfortable, said Ms. Miracle; the only equipment you need is a chair or surface on which to sit upright with your feet on the ground. By tending to your pelvic floor before there’s an issue, she said, you can help to ward off problems down the road.

Diaphragmatic breathing

CreditCredit…Gritchelle Fallesgon for The New York Times

Learning how to move the diaphragm is key to connecting with, and then conditioning, your pelvic floor muscles.

  • Sit in a chair with your feet flat on the ground. Place one hand on your belly and one hand on your chest
  • Inhale and feel your belly expand, then exhale slowly through your mouth. (It might help to imagine a balloon in your belly: As you inhale, the balloon fills with air; as you exhale, the air slowly releases, as if your thumb were covering the opening and gradually letting it seep out.) Repeat 10 times.

Pelvic floor lengthening exercise

CreditCredit…Gritchelle Fallesgon for The New York Times

The next step in exercising the pelvic floor is learning how to relax and lengthen the muscles, so they are capable of a full range of motion. The ability to relax the pelvis is especially important for basic functions like using the bathroom without strain (think: avoiding constipation) and having penetrative sex without pain.

  • Lie comfortably on your back with your knees bent and your feet flat on the ground.
  • Start with diaphragmatic breathing, inhaling deeply and allowing air to fill the bottom of your lungs. Feel your low belly, lower back and pelvic floor gently stretch — or lengthen — outward with your breath.
  • Exhale slowly through pursed lips, allowing your belly, back and pelvic floor to passively relax. Do not engage any muscles during the exhale,; keep your pelvic floor fully rested. Imagine the above balloon expanding 360 degrees in all directions on the inhale. One of those directions is downward between your legs and toward the perineum (the area between the vagina and anus). As the belly rises passively, the perineum will also balloon down and out passively. Repeat 10 times.

Seated Kegels

CreditCredit…Gritchelle Fallesgon for The New York Times

While the previous exercise helps us relax the pelvic floor muscles, Kegels train us to contract them. This exercise helps us hold in urine, stool or gas when we feel the urge to use the bathroom and also works to build endurance in the pelvic floor muscles, so they’re able to hold up our organs and balance out pressure put on the abdomen throughout the day.

  • Sit upright with your feet flat on the ground.
  • Inhale through your nose, relaxing your pelvic floor as your belly and rib cage expand.
  • As you exhale, squeeze and lift your pelvic floor muscles, holding the contraction for the duration of your exhale. Aim to hold for 10 seconds. It may help to imagine squeezing the muscles that stop the flow of urine in the front and hold back gas in the back — or to imagine these muscles picking up a marble and holding it inside. Be sure to engage the muscles inside your body, as opposed to simply squeezing your thighs or buttocks together.
  • Fully relax for four to 10 seconds — or longer, if you need it. The release is as important as the contraction, since only contracting the muscles without fully releasing can make them overly tight and restrict their range of motion. Complete 3 sets of 10 reps.

Quick flicks

CreditCredit…Gritchelle Fallesgon for The New York Times

This exercise builds on Kegels by training the pelvic floor muscles to contract quickly — a skill that allows them to respond effectively to sudden, automatic bodily functions that create pressure inside the abdomen, such as coughing, sneezing or even laughing. (It can also help to prevent incontinence, or “leaking,” in the face of this pressure.)

  • Sit upright with your feet flat on the ground.
  • Repeatedly contract and release the muscles that stop the flow of urine, aiming for a cadence of at least 7 squeezes over 10 seconds. Complete at least 30 squeeze-and-releases.

“The Knack” with a “shhh” sound

CreditCredit…Gritchelle Fallesgon for The New York Times

While quick flicks train the pelvic floor muscles to respond quickly to the kinds of sudden bodily functions that put pressure on the abdomen (as discussed above), this exercise helps to build strength and endurance in the face of this pressure.

  • Sit upright with your feet flat on the ground.
  • Inhale through your nose, relaxing your pelvic floor as your rib cage and belly expand.
  • As you begin to exhale, squeeze and lift your pelvic floor muscles, then perform a quick, forceful and audible “shh” sound from your mouth while maintaining the hold.
  • From there, exhale fully slowly through pursed lips, allowing your belly, back and pelvic floor to passively recoil. Complete 3 sets of 10 reps.

Belly lifts

CreditCredit…Gritchelle Fallesgon for The New York Times

This exercise targets your transverse abdominis muscles, which sit in the lower abdomen and support the core. These muscles work together with the pelvic floor muscles to help you with everything from sitting and standing to doing any workout that requires balance or stability. Learning to actively engage these muscles is a skill most of us have never been taught.

  • Start on your hands and knees, with your hands under shoulders and knees under hips. Focus your gaze between your hands.
  • Inhale, filling your belly with air and relaxing it toward the ground.
  • Exhale and pull your belly button in toward your spine. This should activate your transverse abdominal muscles. Be sure to keep your back flat and unmoving for the duration of the movement; your belly is the only thing that moves. (If you need a visual, imagine your belly is again full of air, like a balloon — now squeeze the air out of your balloon using your ab muscles, tightening them to your spine.) Repeat 10 times.

Danielle Friedman is a journalist in New York City and author of “Let’s Get Physical: How Women Discovered Exercise and Reshaped the World.”

Produced by Deanna Donegan and Tiffanie Graham.

Women Have Been Misled About Menopause

Women Have Been Misled About Menopause

Hot flashes, sleeplessness, pain during sex: For some of menopause’s worst symptoms, there’s an established treatment. Why aren’t more women offered it?

Credit…Marta Blue for The New York Times

  • Published Feb. 1, 2023Updated Feb. 15, 2023

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For the past two or three years, many of my friends, women mostly in their early 50s, have found themselves in an unexpected state of suffering. The cause of their suffering was something they had in common, but that did not make it easier for them to figure out what to do about it, even though they knew it was coming: It was menopause.

The symptoms they experienced were varied and intrusive. Some lost hours of sleep every night, disruptions that chipped away at their mood, their energy, the vast resources of good will that it takes to parent and to partner. One friend endured weeklong stretches of menstrual bleeding so heavy that she had to miss work. Another friend was plagued by as many as 10 hot flashes a day; a third was so troubled by her flights of anger, their intensity new to her, that she sat her 12-year-old son down to explain that she was not feeling right — that there was this thing called menopause and that she was going through it. Another felt a pervasive dryness in her skin, her nails, her throat, even her eyes — as if she were slowly calcifying.

What to Know About Menopause and Hormone Therapy

Feb. 1, 2023

Then last year, I reached the same state of transition. Technically, it is known as perimenopause, the biologically chaotic phase leading up to a woman’s last period, when her reproductive cycle makes its final, faltering runs. The shift, which lasts, on average, four years, typically starts when women reach their late 40s, the point at which the egg-producing sacs of the ovaries start to plummet in number. In response, some hormones — among them estrogen and progesterone — spike and dip erratically, their usual signaling systems failing. During this time, a woman’s period may be much heavier or lighter than usual. As levels of estrogen, a crucial chemical messenger, trend downward, women are at higher risk for severe depressive symptoms. Bone loss accelerates. In women who have a genetic risk for Alzheimer’s disease, the first plaques are thought to form in the brain during this period. Women often gain weight quickly, or see it shift to their middles, as the body fights to hold onto the estrogen that abdominal fat cells produce. The body is in a temporary state of adjustment, even reinvention, like a machine that once ran on gas trying to adjust to solar power, challenged to find workarounds.

I knew I was in perimenopause because my period disappeared for months at a time, only to return with no explanation. In the weeks leading up to each period, I experienced abdominal discomfort so extreme that I went for an ultrasound to make sure I didn’t have some ever-growing cyst. At times, hot flashes woke me at night, forcing me straight into the kinds of anxious thoughts that take on ferocious life in the early hours of morning. Even more distressing was the hard turn my memory took for the worse: I was forever blanking on something I said as soon as I’d said it, chronically groping for words or names — a development apparent enough that people close to me commented on it. I was haunted by a conversation I had with a writer I admired, someone who quit relatively young. At a small party, I asked her why. “Menopause,” she told me without hesitation. “I couldn’t think of the words.”

‘It suggests that we have a high cultural tolerance for women’s suffering. It’s not regarded as important.’

My friends’ reports of their recent doctors’ visits suggested that there was no obvious recourse for these symptoms. When one friend mentioned that she was waking once nightly because of hot flashes, her gynecologist waved it off as hardly worth discussing. A colleague of mine seeking relief from hot flashes was prescribed bee-pollen extract, which she dutifully took with no result. Another friend who expressed concerns about a lower libido and vaginal dryness could tell that her gynecologist was uncomfortable talking about both. (“I thought, hey, aren’t you a vagina doctor?” she told me. “I use that thing for sex!”)

Their doctors’ responses prompted me to contemplate a thought experiment, one that is not exactly original but is nevertheless striking. Imagine that some significant portion of the male population started regularly waking in the middle of the night drenched in sweat, a problem that endured for several years. Imagine that those men stumbled to work, exhausted, their morale low, frequently tearing off their jackets or hoodies during meetings and excusing themselves to gulp for air by a window. Imagine that many of them suddenly found sex to be painful, that they were newly prone to urinary-tract infections, with their penises becoming dry and irritable, even showing signs of what their doctors called “atrophy.” Imagine that many of their doctors had received little to no training on how to manage these symptoms — and when the subject arose, sometimes reassured their patients that this process was natural, as if that should be consolation enough.

Now imagine that there was a treatment for all these symptoms that doctors often overlooked. The scenario seems unlikely, and yet it’s a depressingly accurate picture of menopausal care for women. There is a treatment, hardly obscure, known as menopausal hormone therapy, that eases hot flashes and sleep disruption and possibly depression and aching joints. It decreases the risk of diabetes and protects against osteoporosis. It also helps prevent and treat menopausal genitourinary syndrome, a collection of symptoms, including urinary-tract infections and pain during sex, that affects nearly half of postmenopausal women.

A posed photograph of a middle-aged woman, cropped tightly to show her ear and part of her face, with drops of sweat visible on her face.

Menopausal hormone therapy was once the most commonly prescribed treatment in the United States. In the late 1990s, some 15 million women a year were receiving a prescription for it. But in 2002, a single study, its design imperfect, found links between hormone therapy and elevated health risks for women of all ages. Panic set in; in one year, the number of prescriptions plummeted. Hormone therapy carries risks, to be sure, as do many medications that people take to relieve serious discomfort, but dozens of studies since 2002 have provided reassurance that for healthy women under 60 whose hot flashes are troubling them, the benefits of taking hormones outweigh the risks. The treatment’s reputation, however, has never fully recovered, and the consequences have been wide-reaching. It is painful to contemplate the sheer number of indignities unnecessarily endured over the past 20 years: the embarrassing flights to the bathroom, the loss of precious sleep, the promotions that seemed no longer in reach, the changing of all those drenched sheets in the early morning, the depression that fell like a dark curtain over so many women’s days.

About 85 percent of women experience menopausal symptoms. Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, believes that, in general, menopausal women have been underserved — an oversight that she considers one of the great blind spots of medicine. “It suggests that we have a high cultural tolerance for women’s suffering,” Thurston says. “It’s not regarded as important.”

Even hormone therapy, the single best option that is available to women, has a history that reflects the medical culture’s challenges in keeping up with science; it also represents a lost opportunity to improve women’s lives.

“Every woman has the right — indeed the duty — to counteract the chemical castration that befalls her during her middle years,” the gynecologist Robert Wilson wrote in 1966. The U.S. Food and Drug Administration approved the first hormone-therapy drug in 1942, but Wilson’s blockbuster book, “Feminine Forever,” can be considered a kind of historical landmark — the start of a vexed relationship for women and hormone therapy. The book was bold for its time, in that it recognized sexual pleasure as a priority for women. But it also displayed a frank contempt for aging women’s bodies and pitched hormones in the service of men’s desires: Women on hormones would be “more generous” sexually and “easier to live with.” They would even be less likely to cheat. Within a decade of the book’s publication, Premarin — a mix of estrogens derived from the urine of pregnant horses — was the fifth-most-prescribed drug in the United States. (Decades later, it was revealed that Wilson received funding from the pharmaceutical company that sold Premarin.)

In 1975, alarming research halted the rise of the drug’s popularity. Menopausal women who took estrogen had a significantly increased risk of endometrial cancer. Prescriptions dropped, but researchers soon realized that they could all but eliminate the increased risk by prescribing progesterone, a hormone that inhibits the growth of cells in the uterus lining. The number of women taking hormones started rising once again, and continued rising over the next two decades, especially as increasing numbers of doctors came to believe that estrogen protected women from cardiovascular disease. Women’s heart health was known to be superior to men’s until they hit menopause, at which point their risk for cardiovascular disease quickly skyrocketed to meet that of age-matched men. In 1991, an observational study of 48,000 postmenopausal nurses found that those who took hormones had a 50 percent lower risk of heart disease than those who did not. The same year, an advisory committee suggested to the F.D.A. that “virtually all” menopausal women might be candidates for hormone therapy. “When I started out, I had a slide that said estrogen should be in the water,” recalls Hadine Joffe, a psychiatry professor at Harvard Medical School who studies menopause and mood disorders. “We thought it was like fluoride.”

Feminist perspectives on hormone therapy varied. Some perceived it as a way for women to control their own bodies; others saw it as an unnecessary medicalization of a natural process, a superfluous product designed to keep women sexually available and conventionally attractive. For many, the issue lay with its safety: Hormone therapy had already been aggressively marketed to women in the 1960s without sufficient research, and many women’s health advocates believed that history was repeating itself. The research supporting its health benefits came from observational studies, which meant that the subjects were not randomly assigned to the drug or a placebo. That made it difficult to know if healthier women were choosing hormones or if hormones were making women healthier. Women’s health advocates, with the support of the feminist congresswoman Patricia Schroeder, called on the National Institutes of Health to run long-term, randomized, controlled trials to determine, once and for all, whether hormones improved women’s cardiovascular health.

In 1991, Bernadine Healy, the first woman to serve as director of the N.I.H., started the Women’s Health Initiative, which remains the largest randomized clinical trial in history to involve only women, studying health outcomes for 160,000 postmenopausal women, some of them over the course of 15 years. Costs for just one aspect of its research, the hormone trial, would eventually run to $260 million. The hormone trial was expected to last about eight years, but in June 2002, word started spreading that one arm of the trial — in which women were given a combination of estrogen and progestin, a synthetic form of progesterone — had been stopped prematurely. Nanette Santoro, a reproductive endocrinologist who had high hopes for hormones’ benefit on heart health, told me she was so anxious to know why the study was halted that she could barely sleep. “I kept waking my husband up in the middle of the night to say, ‘What do you think?’” she recalled. Alas, her husband, an optometrist, could scarcely illuminate the situation.

‘When I started out, I had a slide that said estrogen should be in the water. We thought it was like fluoride.’

Santoro did not have to wait long. On July 9, the Women’s Health Initiative’s steering committee organized a major news conference in the ballroom of the National Press Club in Washington to announce both the halting of the study and its findings, a week before the results would be publicly available for doctors to read and interpret. Jaques Rossouw, an epidemiologist who was the acting director of the W.H.I., told the gathered press that the study had found both adverse effects and benefits of hormone therapy, but that “the adverse effects outweigh and outnumber the benefits.” The trial, Rossouw said, did not find that taking hormones protected women from heart disease, as many had hoped; on the contrary, it found that hormone therapy carried a small but statistically significant increased risk of cardiac events, strokes and clots — as well as an increased risk of breast cancer. He described the increased risk of breast cancer as “very small,” or more precisely: “less than a tenth of 1 percent per year” for an individual woman.

What happened next was an exercise in poor communication that would have profound repercussions for decades to come. Over the next several weeks, researchers and news anchors presented the data in a way that caused panic. On the “Today” show, Ann Curry interviewed Sylvia Wassertheil-Smoller, an epidemiologist who was one of the chief investigators for the W.H.I. “What made it ethically impossible to continue the study?” Curry asked her. Wassertheil-Smoller responded, “Well, in the interest of safety, we found there was an excess risk of breast cancer.” Curry rattled off some startling numbers: “And to be very specific here, you actually found that heart disease, the risk increased by 29 percent. The risks of strokes increased by 41 percent. It doubled the risk of blood clots. Invasive breast cancer risk increased by 26 percent.”

All of those statistics were accurate, but for a lay audience, they were difficult to interpret and inevitably sounded more alarming than was appropriate. The increase in the risk of breast cancer, for example, could also be presented this way: A woman’s risk of having breast cancer between the ages of 50 and 60 is around 2.33 percent. Increasing that risk by 26 percent would mean elevating it to 2.94 percent. (Smoking, by contrast, increases cancer risk by 2,600 percent.) Another way to think about it is that for every 10,000 women who take hormones, an additional eight will develop breast cancer. Avrum Bluming, a co-author of the 2018 book “Estrogen Matters,” emphasized the importance of putting that risk and others in context. “There is a reported risk of pulmonary embolism among postmenopausal women taking estrogen,” Bluming says. “But what is ‘risk’? The risk of embolism is similar to the risk of being on oral contraceptives or being pregnant.”

The study itself was designed with what would come to be seen as a major flaw. W.H.I. researchers wanted to be able to measure health outcomes — how many women ended up having strokes, heart attacks or cancer — but those ailments may not show up until women are in their 70s or 80s. The study was scheduled to run for only 8½ years. So they weighted the participants toward women who were already 60 or older. That choice meant that women in their 50s, who tended to be healthier and have more menopausal symptoms, were underrepresented in the study. At the news conference, Rossouw started out by saying that the findings had “broad applicability,” emphasizing that the trial found no difference in risk by age. It would be years before researchers appreciated just how wrong that was.

The “Today” segment was just one of several media moments that triggered an onslaught of panicked phone calls from women to their doctors. Mary Jane Minkin, a practicing OB-GYN and a clinical professor at Yale School of Medicine, told me she was apoplectic with frustration; she couldn’t reassure her patients, if reassurance was even in order (she came to think it was), because the findings were not yet publicly available. “I remember where I was when John Kennedy was shot,” Minkin says. “I remember where I was on 9/11. And I remember where I was when the W.H.I. findings came out. I got more calls that day than I’ve ever gotten before or since in my life.” She believes she spoke to at least 50 patients on the day of the “Today” interview, but she also knows that countless other patients did not bother to call, simply quitting their hormone therapy overnight.

Within six months, insurance claims for hormone therapy had dropped by 30 percent, and by 2009, they were down by more than 70 percent. JoAnn Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital and one of the chief investigators in the study, described the fallout as “the most dramatic sea change in clinical medicine that I have ever seen.” Newsweek characterized the response as “near panic.” The message that took hold then, and has persisted ever since, was a warped understanding of the research that became a cudgel of a warning: Hormone therapy is dangerous for women.

The full picture of hormone therapy is now known to be far more nuanced and reassuring. When patients tell Stephanie Faubion, the director of the Mayo Clinic Center for Women’s Health, that they’ve heard that hormones are dangerous, she has a fairly consistent response. “I sigh,” Faubion told me. She knows she has some serious clarifying to do.

Faubion, who is also the medical director of the North American Menopause Society (NAMS), an association of menopause specialists, says the first question patients usually ask her is about breast-cancer risk. She explains that in the W.H.I. trial, women who were given a combination of estrogen and progestin saw an increased risk emerge only after five years on hormones — and even after 20 years, the mortality rate of women who took those hormones was no higher than that of the control group. (Some researchers have hope that new formulations of hormone therapy will lessen the risk of breast cancer. One major observational study published last year suggested so, but that research is not conclusive.)

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The biggest takeaway from the last two decades of research is that age matters: For women who go through early menopause, before age 45, hormone therapy is recommended because they’re at greater risk for osteoporosis if they don’t receive hormones up until the typical age of menopause. For healthy women in their 50s, life-threatening events like clots or stroke are rare, and so the increased risks from hormone therapy are also quite low. When Manson, along with Rossouw, did a reanalysis of the W.H.I. findings, she found that women under 60 in the trial had no elevated risk of heart disease.

‘I remember where I was when John Kennedy was shot. I remember where I was on 9/11. And I remember where I was when the W.H.I. findings came out.’

The findings, however, did reveal greater risks for women who start hormone therapy after age 60. Manson’s analyses found that women had a small elevated risk of coronary heart disease if they started taking hormones after age 60 and a significant elevated risk if they started after age 70. It was possible, researchers have hypothesized, that hormones may be most effective within a certain window, perpetuating the well-being of systems that are still healthy but accelerating damage in those already in decline. (No research has yet followed women who start in their 50s and stay on continuously into their 60s.)

Researchers also now have a better appreciation of the benefits of hormone therapy. Even at the time that the W.H.I. findings were released, the data showed at least one clear improvement resulting from hormone therapy: Women had 24 percent fewer fractures. Since then, other positive results have emerged. The incidence of diabetes, for instance, was found to be 20 percent lower in women who took hormones, compared with those who took a placebo. In the W.H.I. trial, women who had hysterectomies — 30 percent of American women by age 60 — were given estrogen alone because they did not need progesterone to protect them from endometrial cancer, and that group had lower rates of breast cancer than the placebo group. “Nonetheless,” Bluming and his co-author, Carol Tavris, write in “Estrogen Matters,” “we have yet to see an N.I.H. press conference convened to reassure women of the benefits of estrogen.” Anything short of that, they argue, allows misrepresentations and fears to persist.

Positive reports about hormone therapy for women in their 50s started emerging as early as 2003, and they have never really slowed. But the revelations have come in a trickle, with no one story gaining the kind of exposure or momentum of the W.H.I. news conference. In 2016, Manson tried to rectify the problem in an article for The New England Journal of Medicine, issuing a clear course correction of the W.H.I. findings as they pertained to women in their 40s and 50s. Since she published that paper, she feels, attitudes have changed, but too slowly. Manson frequently speaks to the press, and as the years passed — and more data accumulated that suggested the risks were not as alarming as they were first presented — you can almost track her increasing frustration in her public comments. “Women who would be appropriate candidates are being denied hormone therapy for the treatment of their symptoms,” she told me in a recent interview. She was dismayed that some doctors were not offering relief to women in their 50s on the basis of a study whose average subject age was 63 — and in which the risk assessments were largely driven by women in their 70s. “We’re talking about literally tens of thousands of clinicians who are reluctant to prescribe hormones.”

Even with new information, doctors still find themselves in a difficult position. If they rely on the W.H.I., they have the benefit of a gold-standard trial, but one that focused on mostly older women and relied on higher doses and different formulations of hormones from those most often prescribed today. New formulations more closely mimic the natural hormones in a woman’s body. There are also new methods of delivery: Taking hormones via transdermal patch, rather than a pill, allows the medication to bypass the liver, which seems to eliminate the risk of clots. But the studies supporting the safety of newer options are observational; they have not been studied in long-term, randomized, controlled trials.

The NAMS guidelines emphasize that doctors should make hormone-therapy recommendations based on the personal health history and risk factors of each patient. Many women under 60, or within 10 years of menopause, already have increased baseline risks for chronic disease, because they are already trying to manage their obesity, hypertension, diabetes or high cholesterol. Even so, Faubion says that “there are few women who have absolute contraindications,” meaning that for them, hormones would be off the table. At highest risk from hormone use are women who have already had a heart attack, breast cancer or a stroke or a blood clot, or women with a cluster of significant health problems. “For everyone else,” Faubion says, “the decision has to do with the severity of symptoms as well as personal preferences and level of risk tolerance.”

For high-risk women, other sources of relief exist: The selective serotonin reuptake inhibitor paroxetine is approved for the relief of hot flashes, although it is not as effective as hormone therapy. Cognitive-behavioral therapy has also been shown to help women with how much hot flashes bother them. Doctors who treat menopause are waiting for the F.D.A.’s review of a drug up for approval this month: a nonhormonal drug that would target the complex of neurons thought to be involved in triggering hot flashes.

Conversations about the risks and benefits of these various treatments often require more time than the usual 15-minute slot that health insurance will typically reimburse for a routine medical visit. “If I weren’t my own chair, I would be called to task for not doing stuff that would make more money, like delivering babies and I.V.F.,” says Santoro, now the department chair of obstetrics and gynecology at the University of Colorado School of Medicine, who frequently takes on complex cases of menopausal women. “Family medicine generally doesn’t want to deal with this, because who wants to have a 45-minute-long conversation with somebody about the risks and benefits of hormone therapy? Because it’s nuanced and complicated.” Some of those conversations entail explaining that hormones are not a cure-all. “When women come in and tell me they’re taking hormones for anti-aging or general prevention, or because they have some vague sense it’ll return them to their premenopausal self — and they’re not even having hot flashes — I say, ‘Hormone therapy is not a fountain of youth and shouldn’t be used for that purpose,’” Faubion says.

Too many doctors are not equipped to parse these intricate pros and cons, even if they wanted to. Medical schools, in response to the W.H.I., were quick to abandon menopausal education. “There was no treatment considered safe and effective, so they decided there was nothing to teach,” says Minkin, the Yale OB-GYN. About half of all practicing gynecologists are under 50, which means that they started their residencies after the publication of the W.H.I. trial and might never have received meaningful education about menopause. “When my younger partners see patients with menopausal symptoms, they refer them to me,” says Audrey Buxbaum, a 60-year-old gynecologist with a practice in New York. Buxbaum, like many doctors over 50, prescribed menopausal hormone therapy before the W.H.I. and never stopped.

A posed photograph of a middle-aged woman, cropped tightly to show her neck and part of her face, with her hands kneading the back of her neck.

Education on a stage of life that affects half the world’s population is still wildly overlooked at medical schools. A 2017 survey sent to residents across the country found that 20 percent of them had not heard a single lecture on the subject of menopause, and a third of the respondents said they would not prescribe hormone therapy to a symptomatic woman, even if she had no clear medical conditions that would elevate the risk of doing so. “I was quizzing my daughter a few years ago when she was studying for the board exams, and whoever writes the board questions, the answer is never, ‘Give them hormones,’” Santoro says. In recent years, there has been some progress: The University of Pennsylvania has established a menopause clinic, and Johns Hopkins now offers classroom instruction and hands-on experience for its residents. But the field of gynecology will, most likely for decades to come, be populated by many doctors who left medical school unprepared to offer guidance to menopausal women who need their help.

I didn’t know all of this when I went to see my gynecologist. I knew only what my friends had told me, and that hormone therapy was an option. The meeting was only my second with this gynecologist, a woman who struck me as chic, professional and in a bit of a hurry, which was to be expected, as she is part of a large health care group — the kind that makes you think you’d rather die from whatever’s ailing you than try to navigate its phone tree one more time. Something about the quick pace of the meeting — the not-so-frequent eye contact — made me hesitate before bringing up my concerns: They felt whiny, even inappropriate. But I forged on. I was having hot flashes, I told her — not constantly, but enough that it was bothering me. I had other concerns, but since memory issues were troubling me the most, I brought that up next. “But that could also just be normal aging,” she said. She paused and fixed a doubtful gaze in my direction. “We only prescribe hormones for significant symptoms,” she told me. I felt rebuffed, startled by how quickly the conversation seemed to have ended, and I was second-guessing myself. Were my symptoms, after all, “significant”? By whose definition?

The NAMS guidelines suggest that the benefits of hormone therapy outweigh the risks for women under 60 who have “bothersome” hot flashes and no contraindications. When I left my doctor’s office (without a prescription), I spent a lot of time thinking about whether my symptoms were troubling me enough to take on any additional risk, no matter how small. On the one hand, I was at a healthy weight and active, at relatively low risk for cardiovascular disease; on the other hand, because of family history and other factors, I was at higher risk for breast cancer than many of my same-age peers. I felt caught between the promises and, yes, risks of hormone therapy, the remaining gaps in our knowledge and my own aversion, common if illogical, to embarking on a new and indefinitely lasting medical regimen.

‘Menopause has the worst P.R. campaign in the history of the universe, because it’s not just hot flashes and night sweats.’

Menopause could represent a time when women feel maximum control of our bodies, free at last from the risk of being forced to carry an unwanted pregnancy. And yet for many women, menopause becomes a new struggle to control our bodies, not because of legislation or religion but because of a lack of knowledge on our part, and also on the part of our doctors. Menopause presents not just a new stage of life but also a state of confusion. At a time when we have the right to feel seasoned, women are thrust into the role of newbie, or worse, medical detective, in charge of solving our own problems.

Even the most resourceful women I know, the kind of people you call when you desperately need something done fast and well, described themselves as “baffled” by this stage of their lives. A recent national poll found that 35 percent of menopausal women reported that they had experienced four or more symptoms, but only 44 percent said they had discussed their symptoms with a doctor. Women often feel awkward initiating those conversations, and they may not even identify their symptoms as menopausal. “Menopause has the worst P.R. campaign in the history of the universe, because it’s not just hot flashes and night sweats,” says Rachel Rubin, a sexual-health expert and assistant clinical professor in urology at Georgetown University. “How many times do I get a 56-year-old woman who comes to me, who says, Oh, yeah, I don’t have hot flashes and night sweats, but I have depression and osteoporosis and low libido and pain with sex? These can all be menopausal symptoms.” In an ideal world, Rubin says, more gynecologists, internists and urologists would run through a list of hormonal symptoms with their middle-aged patients rather than waiting to see if those women have the knowledge and wherewithal to bring them up on their own.

The W.H.I. trial measured the most severe, life-threatening outcomes: breast cancer, heart disease, stroke and clots, among others. But for a woman who is steadily losing hair, who has joint pain, who suddenly realizes her very smell has changed (and not for the better) or who is depressed or exhausted — for many of those women, the net benefits of taking hormones, of experiencing an improved quality of life day to day, may be worth facing down whatever incremental risks hormone therapy entails, even after age 60. Even for women like me, whose symptoms are not as drastic but whose risks are low, hormones can make sense. “I’m not saying every woman needs hormones,” Rubin says, “but I’m a big believer in your body, your choice.”

Conversations about menopause lack, among so many other things, the language to help us make these choices. Some women sail blissfully into motherhood, but there is a term for the extreme anxiety and depression that other women endure following delivery: postpartum depression. Some women menstruate every month without major upheaval; others experience mood changes that disrupt their daily functioning, suffering what we call premenstrual syndrome (PMS), or in more serious cases, premenstrual dysphoric disorder. A significant portion of women suffer no symptoms whatsoever as they sail into menopause. Others suffer near-systemic breakdowns, with brain fog, recurring hot flashes and exhaustion. Others feel different enough to know they don’t like what they feel, but they are hardly incapacitated. Menopause — that baggy term — is too big, too overdetermined, generating a confusion that makes it especially hard to talk about.

No symptom is more closely associated with menopause than the hot flash, a phenomenon that’s often reduced to a comedic trope — the middle-aged woman furiously waving a fan at her face and throwing ice cubes down her shirt. Seventy to 80 percent of women have hot flashes, yet they are nearly as mysterious to researchers as they are to the women experiencing them — a reflection of just how much we still have to learn about the biology of menopause. Scientists are now trying to figure out whether hot flashes are merely a symptom or whether they trigger other changes in the body.

Strangely, the searing heat a woman feels roaring within is not reflected in any significant rise in her core body temperature. Hot flashes originate in the hypothalamus, an area of the brain rich in estrogen receptors that is both crucial in the reproductive cycle and also functions as a thermostat. Deprived of estrogen, its thermostat now wonky, the hypothalamus is more likely to misread small increases in core body temperature as too hot, triggering a rush of sweat and widespread dilation of the blood vessels in an attempt to cool the body. This also drives up the temperature on the skin. Some women experience these misfirings once a day, others 10 or more, with each one lasting anywhere from seconds to five minutes. On average, women experience them for seven to 10 years.

What hot flashes might mean for a woman’s health is one of the main questions that Rebecca Thurston, the director of the Women’s Biobehavioral Health Laboratory at the University of Pittsburgh, has been trying to answer. Thurston helped lead a study that followed a diverse cohort of 3,000 women over 22 years and found that about 25 percent of them were what she called superflashers: Their hot flashes started long before their periods became irregular, and the women continued to experience them for as many as 14 years, upending the idea that, for most women, hot flashes are an irritating but short-lived inconvenience. Of the five racial and ethnic groups Thurston studied, Black women were found to experience the most hot flashes, to experience them as the most bothersome and to endure them the longest. In addition to race, low socioeconomic status was associated with the duration of women’s hot flashes, suggesting that the conditions of life, even years later, can affect a body’s management of menopause. Women who experienced childhood abuse were 70 percent more likely to report night sweats and hot flashes.

Might those symptoms also signal harm beyond the impact on a woman’s quality of life? In 2016, Thurston published a study in the journal Stroke showing that women who had more hot flashes — at least four a day — tended to have more signs of cardiovascular disease. The link was even stronger than the association between cardiovascular risk and obesity, or cardiovascular risk and high blood pressure. “We don’t know if it’s causal,” Thurston cautions, “or in which direction. We need more research.” There might even be some women for whom the hot flashes do accelerate physical harm and others not, Thurston told me. At a minimum, she says, reports of severe and frequent hot flashes should cue doctors to look more closely at a woman’s cardiac health.

As Thurston was trying to determine the effects of hot flashes on vascular health, Pauline Maki, a professor of psychiatry at the University of Illinois at Chicago, was establishing associations between hot flashes and mild cognitive changes during menopause. Maki had already found a clear correlation between the number of a woman’s hot flashes and her memory performance. Maki and Thurston wondered if they would be able to detect some physical representation of that association in the brain. They embarked on research, published last October, that found a strong correlation between the number of hot flashes a woman has during sleep and signs of damage to the tiny vessels of the brain. At a lab in Pittsburgh, which has one of the most powerful M.R.I. machines in the world, Thurston showed me an image of a brain with tiny lesions represented as white dots, ghostlike absences on the scan. Both their number and placement, she said, were different in women with high numbers of hot flashes. But whether the hot flashes were causing the damage or the changes in the cerebral vessels were causing the hot flashes, she could not say.

About 20 percent of women experience cognitive decline during perimenopause and in the first years after menopause, mostly in the realm of verbal learning, the acquisition and synthesis of new information. But the mechanisms of that decline are varied. As estrogen levels drop, the region of the brain associated with verbal learning is thought to recruit others to support its functioning. It’s possible that this period of transition, when the brain is forming new pathways, accounts for the cognitive dip that some women experience. For most of them, it’s short-lived, a temporary neurological confusion. A woman’s gray matter — the cells that process information — also seems to shrink in volume before stabilizing in most women, according to Lisa Mosconi, an associate professor of neurology at Weill Cornell Medicine and director of its Women’s Brain Initiative. She compares the process the brain undergoes during those years of transition to a kind of “remodeling.” But the tiny brain lesions that Thurston and Maki detected don’t resolve — they remain, contributing incrementally, over many years, to an increased risk of cognitive decline and dementia.

In the past 15 years, four randomized, controlled trials found that taking estrogen had no effect on cognitive performance. But those four studies, Maki points out, did not look specifically at women with moderate to severe hot flashes. She believes that might be the key factor: Treat the hot flashes with estrogen, Maki theorizes, and researchers might see an improvement in cognitive health. In one small trial Maki conducted of about 36 women, all of whom had moderate to severe hot flashes, half of the group received a kind of anesthesia procedure that reduced their hot flashes, and the other half received a placebo treatment. She measured the cognitive function of both groups before the treatment and then three months after and found that as hot flashes improved, memory improved. The trial was small but “hypothesis generating,” she says.

Even adjusting for greater longevity in women, Alzheimer’s disease is more frequent in women than men, one of many brain-health discrepancies that have led researchers to wonder about the role that estrogen — and possibly hormone therapy — might play in the pathways of cognitive decline. But the research on hormone therapy and Alzheimer’s disease has proved inconclusive so far.

Whatever research exists on hormones and the brain focuses on postmenopausal women, which means it’s impossible to know, for now, whether perimenopausal women could conceivably benefit from taking estrogen and progesterone during the temporary dip in their cognitive function. “There hasn’t been a single randomized trial of hormone therapy for women in perimenopause,” Maki says. “Egregious, right?”

What’s also unclear, Thurston says, is how the various phenomena of cognitive change during menopause — the temporary setbacks that resolve, the progress toward Alzheimer’s in women with high genetic risk and the onset of those markers of small-vessel brain disease — interact or reflect on one another. “We haven’t followed women long enough to know,” says Thurston, who believes that menopause care begins and ends with one crucial dictum: “We need more research.”

A posed photograph of a middle-aged woman, cropped tightly to show her neck and part of her torso, with her hands in sharp focus in front of her chest and her fingers winding together.

In the information void, a vast menopausal-wellness industry has developed, flush with products that Faubion dismisses as mostly “lotions and potions.” But a new crop of companies has also come to market to provide F.D.A.-approved treatments, including hormone therapy. Midi Health offers virtual face-to-face access to menopause-trained doctors and nurse practitioners who can prescribe hormones that some insurances will cover; other sites, like Evernow and Alloy, sell prescriptions directly to the patient. (Maki serves on the medical advisory boards of both Midi and Alloy.)

On the Alloy website, a woman answers a series of questions about her symptoms, family and medical history, and the company’s algorithm recommends a prescription (or doesn’t). A prescribing doctor reviews the case and answers questions by text or phone, and if the woman decides to complete the order, she has access to that prescribing doctor by text for as long as the prescription is active.

Alloy holds online support groups where women, clearly of varying socioeconomic backgrounds, often vent — about how hard it was for them to find relief, how much they are still suffering or how traumatized they still are by the lack of compassion and concern they encountered when seeking help for distressing symptoms. On one call in July, a middle-aged woman described severe vaginal dryness. “When I was walking or trying just to exercise, I would be in such agony,” she said. “It’s painful just to move.” She was trying to buy vaginal estradiol cream, an extremely low-risk treatment for genitourinary syndrome; she said there was a shortage of it in her small town. Until she stumbled on Alloy, she’d been relying on antibacterial creams to soothe the pain she felt.

The space was clearly a no-judgment zone, a place where women could talk about how they personally felt about the risks and benefits of taking hormones. At one meeting, a woman said that she’d been on hormone therapy, which she said “changed my life” during perimenopause, but that she and her sisters both had worrying mammograms at the same time. Her sister was diagnosed with breast cancer and had her lymph nodes removed; the woman on the call was diagnosed with atypical hyperplasia, which is not cancer but is considered a precursor that puts a woman at high risk. The NAMS guidelines do not indicate that hormone therapy is contraindicated for a woman at high risk of breast cancer, leaving it up to the woman and her practitioner to decide. “My new OB-GYN and my cancer doc won’t put me on hormones,” the woman said. She bought them from Alloy instead. “So I’m kind of under the radar.”

No one at the meeting questioned the woman’s decision to go against the advice of two doctors. I mentioned the case to Faubion. “It sounds to me like she felt she wasn’t being heard by her doctors and had to go somewhere else,” she said. Faubion told me that in certain circumstances, higher-risk women who are fully informed of the risks but suffer terrible symptoms might reasonably make the decision to opt for hormones. But, she said, those decisions require nuanced, thoughtful conversations with health care professionals, and she wondered whether Alloy and other online providers were set up to allow for them. Anne Fulenwider, one of Alloy’s founders, said the patient in the support group had not disclosed her full medical history when seeking a prescription. After that came to light, an Alloy doctor reached out to her to have a more informed follow-up conversation about the risks and benefits of hormone therapy.

As I weighed my own options, I sometimes asked the doctors I interviewed outright for their advice. For women in perimenopause, who are still at risk of pregnancy, I learned, a low-dose birth control can “even things out,” suppressing key parts of the reproductive system and supplying a steadier dose of hormones. Another alternative is an intrauterine device (IUD) to provide birth control, along with a low-dose estrogen patch, which is less potent than even a low-dose birth-control pill and is therefore thought to be safer. “Too much equipment,” I told Rachel Rubin, the sexual-health expert, when she suggested it. “This is why I don’t ski.” I found myself thinking often about an insight that Santoro says she offers her patients (especially those under 60 and in good health): If you’re having any symptoms, how can you weigh the risks and benefits if you haven’t experienced the extent of the benefits?

In November, I started on a low-dose birth-control pill. I am convinced — and those close to me are convinced — that my brain is more glitch-free. I have no hot flashes. Most surprising to me (and perhaps the main reason for that improvement in cognition): My sleep improved. I had not even mentioned my poor quality of sleep to my gynecologist, given the length of our discussion, but I had also assumed that it was a result of stress, age and a sweet but snoring husband. Only once I took the hormones did I appreciate that my regular 2 a.m. wakings, too, were most likely a symptom of perimenopause. The pill was an easy-enough experiment, but it carried a potentially higher risk of clots than the IUD and patch; now convinced that the effort of an IUD is worth it, I resolved to make that switch as soon as I could get an appointment.

How many women are doing some version of what I did, unsure of or explaining away menopausal symptoms, apologizing for complaining about discomforts they’re not sure are “significant,” quietly allowing the conversation to move on when they meet with their gynecologists or internists or family-care doctors? And yet … my more smoothly functioning brain goes round and round, wondering, worrying, waiting for more high-quality research. Maybe in the next decade, when my personal risks start escalating, we’ll know more; all I can hope is that it confirms the current trend toward research that reassures. The science is continuing. We wait for progress, and hope it is as inevitable as aging itself

Dangers of Processed foods

State of Healthcare > Public Health

Ultra-processed food is everywhere. The health risks go deeper than we realized

Published September 14, 2022 | Originally published on ScienceAlert Latest

In countries such as the UK, US and Canada, ultra-processed foods now account for 50 percent or more of calories consumed.

This is concerning, given that these foods have been linked to a number of different health conditions, including a greater risk of obesity and various chronic diseases such as cardiovascular disease and dementia.

Ultra-processed foods are concoctions of various industrial ingredients (such as emulsifiers, thickeners, and artificial flavors) amalgamated into food products by a series of manufacturing processes.

Sugary drinks and many breakfast cereals are ultra-processed foods, as are more recent innovations, such as so-called ‘plant-based’ burgers, which are typically made of protein isolates and other chemicals to make the products palatable.

The intense industrial processes used to produce ultra-processed foods destroy the natural structure of the food ingredients and strip away many beneficial nutrients such as fibre, vitamins, minerals, and phytochemicals.

Many of us are well aware that ultra-processed foods are harmful for our health. But it’s been unclear if this is simply because these foods are of poor nutritional value.

Now, two new studies have shown that poor nutrition may not be enough to explain their health risks. This suggests that other factors may be needed to fully explain their health risks.

The role of inflammation

The first study, which looked at over 20,000 Italian adults, found that participants who consumed the highest number of ultra-processed foods had an increased risk of dying prematurely from any cause.

The second study, which looked at over 50,000 US male health professionals, found high consumption of ultra-processed foods was associated with a greater risk of colon cancer.

What’s most interesting about these studies is that the health risks from eating a diet high in ultra-processed foods remained even after they had accounted for the poor nutritional quality of their diets. This suggests that other factors contribute to the harms caused by ultra-processed foods.

It also implies that getting the right nutrients elsewhere in the diet may not be enough to cancel out the risk of disease from consuming ultra-processed foods.

Similarly, attempts by the food industry to improve the nutritional value of ultra-processed foods by adding a few more vitamins may be side-stepping a more fundamental problem with these foods.

So what factors may explain why ultra-processed foods are so harmful to our health?

The Italian study found that inflammatory markers – such as a higher white blood cell count – were higher in groups that ate the most ultra-processed foods.

Our bodies may trigger an inflammatory response for any number of reasons – for example, if we catch a cold or get cut. The body responds by sending signals to our immune cells (such as white blood cells) to attack any invading pathogens (such as bacteria or viruses).

Usually, our inflammatory response resolves quite quickly, but some people may develop chronic inflammation throughout their body. This can cause tissue damage, and is involved in many chronic diseases – such as cancer and cardiovascular disease.

Many studies have found that poor diets can increase inflammation in the body, and that this is linked to higher risk of chronic diseases.

Given that signs of inflammation were seen in participants of the Italian study who ate the most ultra-processed foods, this could suggest that inflammation may contribute to why ultra-processed foods increase disease risk.

Some food additives common in ultra-processed foods (such as emulsifiers and artificial sweeteners) also increase inflammation in the gut by causing changes to the gut microbiome.

Some researchers have theorized that ultra-processed foods increase inflammation because they are recognized by the body as foreign – much like an invading bacteria. So the body mounts an inflammatory response, which has been dubbed ‘fast food fever’. This increases inflammation throughout the body as a result.

Although the US colon cancer study did not establish if inflammation increased in the men consuming the most ultra-processed foods, inflammation is strongly linked with an increased risk of colon cancer.

Research shows that other mechanisms – such as impaired kidney function and toxins in packaging – may also explain why ultra-processed foods cause so many dangerous health problems.

Since inflammatory responses are hard-wired in our bodies, the best way to prevent this from happening is by not eating ultra-processed foods at all.

Some plant-based diets high in natural, unprocessed foods (such as the Mediterranean diet) have also been shown to be anti-inflammatory.

This may also explain why plant-based diets free from ultra-processed foods can help ward off chronic diseases. It’s currently not known to what extent an anti-inflammatory diet can help counteract the effects of ultra-processed foods.

Simply reducing your intake of ultra-processed foods may be a challenge. Ultra-processed foods are designed to be hyper-palatable – and together with persuasive marketing, this can make resisting them an enormous challenge for some people.

These foods are also not labelled as such on food packaging. The best way to identify them is by looking at their ingredients. Typically, things such as emulsifiers, thickeners, protein isolates, and other industrial-sounding products are a sign it’s an ultra-processed food.

But making meals from scratch using natural foods is the best way to avoid the harms of ultra-processed foods.

Richard Hoffman, Associate lecturer, Nutritional Biochemistry, University of Hertfordshire

This article was originally published on ScienceAlert Latest.

More on the major disaster of out time.

I am so upset I can hardly maintain my rage. This is after 3 yearsn of the vaccine program. What is awaiting us down the track, in 4-5 years when the long term effects of mRNA vaccine start to show up. I tried very hard to stop my grandchildren being vacciated, but of course they followed “the experts” I cannot use the Word Vaccine in the heading because when I do WordPress wont publish it – censorship of the worst kind.

Australia’s Drug Regulator Hid Child Vaccine Deaths to “Maintain Public Confidence”

byRebekah Barnett

15 February 2023 1:30 PM

Australia’s drug regulator hid vaccine deaths from the public, concerned that “disclosure could undermine public confidence”, it has been revealed.

The hidden deaths include two children, seven and nine years old, who both suffered fatal cardiac arrests which the Therapeutic Goods Administration (TGA) assessed as causally linked to Covid vaccination,

The revelations come in documents obtained under Freedom of Information (FOI) request by Dr. Melissa McCann. Dr McCann shared the shocking revelation in her address at the Covid Vaccine Conference, hosted by Clive Palmer’s United Australia Party over the weekend in Brisbane, Melbourne and Sydney. The event featured leading ICU physician Dr. Pierre Kory, cardiologist and epidemiologist Dr. Peter McCullough, and McCullough’s collaborator, author John Leake.

Addressing sold-out crowds, Dr. McCann shared the extraordinary lengths she had to go to to extract causality assessment documents relating to the TGA’s investigation of reported deaths after Covid vaccination, which were obtained under FOI request in a process that took six months. Dr McCann lodged the request after seeing an unexpectedly high number of patients coming through her clinic experiencing adverse events after immunisation (AEFIs). She also noticed a high number of serious AEFI reports in the in the DAEN database, including the reported death of a 14 year-old in October 2021.

In her original FOI request, Dr. McCann requested causality assessments for all of the reported deaths in the DAEN database. This request was denied due to the large scope, and in negotiation with the TGA, Dr. McCann agreed to revise down the request to the 11 documents that were eventually handed over, of which 10 related to DAEN death reports.

When the documents were finally provided to Dr. McCann in July 2022, she was dismayed to find that there were multiple reports that the TGA had assessed as causally linked to Covid vaccination, but, with the exception of one death, had not been reported in the TGA’s regular Safety Reports.

Following is a list of deaths that the TGA’s own reports assessed as causally linked to Covid vaccination:

21 year-old female
Case 729139, Document 1
Moderna booster. Fatal AEFIs, including myocarditis, cardiac arrest, renal impairment, femoral artery embolism, spinal cord infarction.
Assessment outcome: “Causal”
* Initially determined as “unclassifiable”. VSIG (FOI 4049 Doc 5) updated the assessment outcome to “causal”.

9 year-old
Case 724023, Document 2
Pfizer vaccination. Fatal AEFI, cardiac arrest.
Assessment outcome: “Causality assessment outcome”

24 year-old female
Case 718277, Document 3
Pfizer vaccination. Fatal AEFI, cardiac arrest.
Assessment outcome: “Causality”

7 year-old male
Case 719838, Document 5
Pfizer vaccination. Fatal AEFI, cardiac arrest.
Assessment outcome: “Causality”

21 year-old male
Case 644148, Document 6
Pfizer vaccination. Fatal AEFI.
Assessment outcome: “? causality”

Of the above five listed deaths, only the first (21 year old female, case 729139) has been published in the TGA Safety Reports, having been added on September 13th 2022. The reported deaths are listed in DAEN, but the causality assessment is not visible to the public.

Australians have been falsely and misleadingly advised by the TGA and official health representatives that out of 973 reported deaths, only 14 have been assessed as being causally linked to the Covid vaccines (13 following Astra Zeneca, one following Moderna).

The causality assessment reports released under FOI prove this statement to be a lie.

TGA Covid Vaccine Safety Report December 15th 2022

The November 2022 TGA Safety Report states that, “There have been no deaths in children or adolescents determined to be linked to COVID-19 vaccination.” But the assessment reports indicating the causal role of the Pfizer vaccine in the cases of the seven and nine year-old children were released to Dr. McCann in July 2022.

The causality assessment reports prove this statement also to be a lie.

TGA Covid Vaccine Safety Report November 3rd 2022

On reading the causality assessments provided to her under the FOI, Dr. McCann felt both shocked and confused. “Why has this information not been provided to health professionals and the public who are making consent decisions? Children are continuing to be vaccinated and this is something that parents deserve to be able to weigh up,” Dr. McCann told Dystopian Down Under.

It gets worse. Dr. McCann was surprised to find that documents 1-10 out of a total 11 documents from the FOI had not been uploaded to the TGA’s public disclosure log, per regular protocol. She emailed the TGA to query why documents 1-10 had been withheld from the disclosure log, and was advised, in a communication on August 24th 2022:

The decision maker for this request decided not to publish documents 1-10 pursuant to section 11c(1)(a) of the FOI Act as they contain sensitive personal information about deceased persons. As you would appreciate, consultation with the families of the deceased was not considered appropriate, and, as such, consultation was not undertaken with those families. Further, the decision maker determined that disclosure of the documents could undermine public confidence and reduce the willingness of the public to report adverse events to the TGA. (emphasis added)

The TGA seems to have assumed that families of the deceased will not want to hear from them. On the contrary, Deb, mother of 21 year-old Natalie (case 729139), told Jab Injuries Australia that the lack of contact from the TGA was, “disgraceful treatment of a grieving mother who could have made a meaningful contribution to their investigations”. Deb says that she has never been contacted by the TGA, and only discovered the causality assessment outcome of her daughter’s death via the TGA’s Safety Report (September 23rd 2022), which she accessed online.

Natalie, DAEN case number 729139

As for the TGA’s assertion that disclosure of the documents could undermine public confidence, one could very well argue the opposite case. Perceived lack of transparency drives public distrust. The last thing the TGA needs is public suspicion that it is burying vaccine deaths. Full transparency is the only way to create and maintain trust in public health. Dr. McCann made this argument in a further communication, but the TGA’s decision against uploading documents 1-10 to the public disclosure log was final.

During this time, Dr. McCann, in partnership with other concerned doctors, repeatedly wrote to the Health Ministers and Adjunct Professor John Skerritt of the TGA to advise them of concerns about vaccine safety, and to call for immediate suspension of the vaccine rollout until an urgent review of adverse event reports could be undertaken.

These correspondences were met alternately with silence, obfuscation or blanket assurances that the TGA was closely monitoring safety, and that the vaccines were safe and effective.

Letter from Adj. Professor John Skerritt to Dr. Melissa McCann, November 22nd 2021

The TGA consistently reports that only 14 of the 973 reported deaths have been causally linked to vaccination. But the contents of FOI 3727 raise questions:

  • How can the TGA’s statement be true? The TGA’s own causality assessments indicate that there are at least four more deaths that TGA has causally linked to vaccination (two adults, two children) which remain unaccounted for in the official count of 14.
  • How many of the 959 deaths that the TGA implies are not causally linked to vaccination have even been investigated? Are 900 reports ‘in progress’? How many have been determined as ‘not causally linked’? Dr. McCann asked the TGA to state the number of causality assessment reports that had been completed, but her request was denied.

Dr. McCann is concerned about the implications for public health and safety: “If everyone is working on the basis that all of these deaths have been investigated and have been determined as not causally linked, well we can’t be sure that that’s the case.”

For now, Dr. McCann is turning her efforts to a Covid Vaccine Class Action, which is expected to file within the month. The Class Action has received over 350 expressions of interest, and the number is still growing.

“Hopefully this class action will force some transparency so that there will be more clarity around how adverse events are reviewed, and how many are likely to be linked to the vaccines,” says Dr McCann.

Yesterday, Federal MP Russell Broadbent added further pressure to the TGA, referring to Dr. McCann’s FOI 3727 in Parliament: “Why has the TGA not responded to doctors who raised these issues with you six months ago, including drawing your attention to those case reports? This information is extremely alarming and demands an immediate response from the TGA.”

Sydney lawyer Tony Nikolic, of AFL Solicitors, has represented parents of children who are disputing the necessity of having their child vaccinated against Covid, and is now seeing cases related to Covid vaccine injury in children as well. Mr. Nikolic told Dystopian Down Under:

In circumstances where child deaths and serious long-term injuries are listed on the TGA DAEN database relating to new and unsatisfactorily tested vaccine technologies, there should be no other response than a complete suspension of injections until independent lawyers and medical professionals conduct a thorough investigation, which should consider any civil wrongs, crimes or other wrongdoing associated to the roll out of injections across Australia.

Australian parents who have concerns that their child has been vaccine injured or is subject to coercion to take a Covid vaccine are invited to contact Mr. Nikolic.

The TGA has been contacted for comment.


Brain-gut axis

Research continues to shed light on the brain-gut axis. A 2022 study published in Translational Psychiatry showed some promising results for alleviating symptoms of major depressive disorder.[6]

The study found that short-term, high-dose probiotic supplements were effective when used as an add-on treatment for depression. In this small study, 21 participants received a probiotic supplement for 31 days in addition to their standard treatment.

Compared with the placebo group of 26 participants, the patients who received the probiotic supplement had scores on the Hamilton Depression Rating scale that decreased over time. The probiotic group also had a lower putamen activation response when viewing neutral faces after receiving the supplements, compared with the control group.

“Our results suggest that an add-on probiotic treatment improves depressive symptoms and maintains healthy enterotypes [and] species richness and increases specific health-related bacterial taxa.”

— Schaub, et al., Translational Psychiatry


It is well worth listening to this TED talk. We spend 1/2 our lives sleeping, so the more we know about it the better.

Role of melatonin in the management of sleep and circadian disorders

Neurologic Conditions > Sleep & Wakefulness Disorders

Role of melatonin in the management of sleep and circadian disorders

By Scott Cunningham, MD, PhD

| Updated October 26, 2022


  1. Key takeaways
  2. Putting it into practice
  3. Why this study matters
  4. Study design
  5. Results and conclusion
  6. Original source

Key Takeaways

  • Patients with psychiatric disorders and sleep/circadian abnormalities benefit from melatonin treatment.

Putting It Into Practice

In most patients with psychiatric disorders and sleep disturbances, a mutation in the circadian clock regulatory gene, decreased endogenous secretion, and/or decreased endogenous secretion secondary to exogenous factors are causal.

In addition to improving sleep disturbances, melatonin has anti-inflammatory and anti-oxidant properties.

Why this study matters

Sleep disorders are more common than not in all psychiatric disorders. Based on the collective literature, the dosing and timing of administering exogenous melatonin should be determined for the underlying psychiatric disorder.

Study design

The literature was searched for studies involving patients with psychiatric disorders and sleep/circadian abnormalities.

Results and conclusion

Exogenous melatonin has been shown to affect sleep onset latency, sleep efficiency, and sleep quality.

Specifically, exogenous melatonin has been shown to be effective in patients with autism, attention-deficit/hyperactivity disorder, and neurocognitive disorders.

Additional, well-designed studies are needed to demonstrate the dosing and time of exogenous melatonin in neurocognitive disorders, which likely have different requirements than affective and anxiety disorders.

Original Source

Moon E, Kim K, Partonen T, et al. Role of melatonin in the management of sleep and circadian disorders in the context of psychiatric illness. Current Psychiatry Reports 2022;

Read the full article on Current Psychiatry Reports.

Melatonin Isn’t a Sleeping Pill. Here’s How to Use It.

Melatonin Isn’t a Sleeping Pill. Here’s How to Use It.

The “vampire hormone” can act like a dose of sunset, tricking your body into feeling like it’s time to sleep.

Amelia Nierenberg

By Amelia Nierenberg

Published Jan. 11, 2022Updated Sept. 28, 2022

Leer en español阅读简体中文版閱讀繁體中文版

Most people think of melatonin as a natural nod-off aid, kind of like chamomile tea in pill form. Even the name of the popular dietary supplement sounds sleepy — that long “o” sound almost makes you yawn mid-word. But melatonin is also a hormone that our brains naturally produce, and hormones, even in minuscule amounts, can have potent effects throughout the body.

“There are some clinical uses for it, but not the way that it’s marketed and used by the vast majority of the general public,” said Jennifer Martin, a psychologist and professor of medicine at the University of California, Los Angeles.

Experts strongly urge people to consult their doctor or a sleep specialist before taking melatonin, in part because the supplement does not address many underlying health problems that may be disrupting sleep. Anxiety can cause insomnia, as can a host of other potentially serious ailments, such as sleep apnea, restless legs syndrome or mood disorders like depression, that may require medical treatment.

Melatonin, however, is relatively inexpensive and readily available at local pharmacies in the United States (in other countries it typically requires a prescription), and many people will go out and buy it on their own. So what’s the best approach to taking melatonin? Here’s what experts had to say.

How does melatonin work?

During the day, the brain’s pea-sized pineal gland remains inactive. A few hours before our natural sleep time, as it starts to get dark outside and the light entering our retina fades, the gland switches on to flood the brain with melatonin.

“Melatonin is sometimes called the ‘hormone of darkness’ or ‘vampire hormone,’” because it comes out at night, said Matthew Walker, a professor of neuroscience and psychology at the University of California, Berkeley, and the author of the book “Why We Sleep.” As levels of melatonin rise, levels of cortisol, the stress hormone, fall. Respiration slows. Soon, our eyelids begin to droop.

Instead of a lights-out trigger, melatonin acts more like a dimmer switch, turning the day functions off and switching night functions on. So taking a melatonin supplement is sort of like taking a dose of sunset, tricking your body into feeling like it’s nighttime. It doesn’t put you to sleep as much as it tells the body that it’s time to sleep.

“It may take several hours,” said Dr. Ilene M. Rosen, a sleep medicine doctor and associate professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, “which is what I think is the misconception about how melatonin is used.”

Melatonin may make you feel a little drowsier when you take it, but it has a bigger impact on regulating the timing of your overall sleep-wake cycle and helping to set the circadian clock, the roughly 24-hour internal timekeeper that tells your body what time of day it is and syncs it with the outside world.

“The impact it has on our sleep depends on the time of day that you take it,” said Dr. Martin, who is also a spokeswoman for the American Academy of Sleep Medicine. “If you took a sleeping pill in the middle of the day, it would make you feel sleepy. If you took melatonin in the middle of the day, it doesn’t really have that effect.”

Hypnotic drugs like Ambien or Benadryl generally cause people to feel sleepy right away, and the sedation effect of those medications “far exceeds that which they obtain from melatonin,” said Dr. Alon Y. Avidan, a professor of neurology and director of the Sleep Disorders Center at U.C.L.A.

In one analysis published in 2013 in PLOS One, which combined results from 19 studies involving 1,683 men and women, people who took melatonin supplements fell asleep seven minutes faster and increased overall sleep time by eight minutes. That may not sound like much, but there was a lot of individual variation, and researchers found that melatonin also improved overall sleep quality, including people’s ability to wake up feeling refreshed.

But there’s no guarantee that melatonin will work for you.

Dr. Sabra Abbott, an assistant professor of neurology in sleep medicine at Northwestern University Feinberg School of Medicine, said the most common complaint she hears from patients is “I tried melatonin and it didn’t work.” Many also feel hung over or groggy the next morning.

Dr. Martin said that in many studies, melatonin does not work any better than a placebo but added, “One caveat I always like to mention, though, is that placebos work pretty well for insomnia.”

We naturally make melatonin in our brains, but only in picogram amounts, or one trillionth of a gram, which Dr. Rosen described as “a whiff of it coming out at dusk.” Over-the-counter melatonin supplements come in much higher milligram doses, or a thousandth of a gram. That’s a big difference, although the amount that ultimately reaches the brain more closely approximates natural levels.

Many experts recommend starting with the smallest available dosage — 0.5 milligrams to 1 milligram, 30 minutes to an hour before bedtime — and seeing how you do from there. If that has no effect, the dose can be gradually increased.

“If you try a dose, stick to it for a few days before you make an adjustment,” Dr. Martin said. “It’s one of those things that may not happen overnight.”

“Keep a close eye on how you feel the next day,” Dr. Abbott said. “Feeling groggy or hung over is a sign that the dose is probably too high.”

The good news: In the short term, at least, melatonin is unlikely to do any harm.

“Compared to most other sleeping pills, the side-effect profile is much better,” and it’s not going to be addictive, said Dr. Bhanu Prakash Kolla, an associate professor of psychiatry and a consultant at the Center for Sleep Medicine at the Mayo Clinic. But because melatonin can cause drowsiness, the Mayo Clinic warns that you shouldn’t drive or operate machinery within five hours of taking it.

“Far and away, the most common side effect that I have patients report to me is that their dreams just become much more vivid,” Dr. Abbott said. Scientists aren’t sure why that happens.

Dr. Kolla has also seen patients who have nightmares or disruptive dreams, which are also common with sleeping pills. “In that case, you want to try to lower the dose,” he said. “Or, if it’s too problematic, stop.”

Sleep doctors may use melatonin to help patients with circadian rhythm disorders regulate their sleep-wake cycles. For example, during the pandemic, Dr. Avidan said, “we’ve seen those people who become super night owls” unable to fall asleep until 2 or 3 a.m.

Experts also suggest people use a bright light in the mornings to help them wake up, which has “alerting properties and can suppress any remaining melatonin production,” said Dr. Abbott.

Should you take melatonin for jet lag?

Jet lag is a circadian rhythm disorder, albeit a temporary one, so melatonin may help. To alleviate the worst effects, doctors recommend consulting one of several online calculators available, which ask you for your destination and arrival points, your flight time and your normal sleep patterns. Two sites that Dr. Avidan recommends are Jet Lag Rooster or the calculator from Fleet Street Clinic.

“They’re trying to tell you when to take the melatonin so your body knows: ‘Oh, it’s dusk where I’m going,’” Dr. Rosen said, explaining how you can use the supplement before your trip to readjust your body clock.

A study published in the Journal of Clinical Sleep Medicine found that the content of more than 70 percent of melatonin supplements varied widely from their label claims. The concentration ranged from 83 percent less than the amount listed to 478 percent more.

Dr. Kolla advised looking for a GLP (good laboratory practice) or GMP (good manufacturing practice) label, which refers to federal regulations designed to affirm a product has the advertised quality and purity. “You really don’t know what you’re getting, so you’re trusting the manufacturer,” he said. Melatonin comes in pills, gummies or liquid; the choice comes down to personal preference, he added.

Sleep doctors strongly urge people with chronic insomnia to seek out cognitive behavioral therapy, a short-term psychological treatment that can help get to the root of the problem.

“If you give melatonin to a patient and you don’t complement it with behavioral therapy for insomnia, you may not necessarily see the effects that you’re looking for,” Dr. Avidan said.

Many common behaviors can also make it harder for us to fall — and stay — asleep, including using our phones near bedtime, which can hamper natural melatonin production. Meditation may help, as can warm showers and cool bedrooms, or giving up caffeine and alcohol.

“There are a lot of other things people could do to help themselves sleep better,” Dr. Martin said. “They’re just harder.

Women Are Calling Out ‘Medical Gaslighting’

Women Are Calling Out ‘Medical Gaslighting’

Go to my Blog of 21st April 2021, and you will find an interesting article on Oprah Winfrey. She was misdiagnosed by the best cardiologists around (She was menopausal) There are lessons to be learned by this.

Studies show female patients and people of color are more likely to have their symptoms dismissed by medical providers. Experts say: Keep asking questions.

Credit…Marta Monteiro

By Melinda Wenner Moyer

March 28, 2022, 5:00 a.m. ET

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Jenneh Rishe could easily run six miles in under 45 minutes — until suddenly she couldn’t. In the spring of 2019, Mrs. Rishe, now 35, began finding her daily jogs a struggle.

Years earlier, she had been diagnosed with two congenital heart conditions that, she said, doctors told her would not affect her daily functioning. Yet she was getting worse: Intense chest pains woke her up at night, and she started using a wheelchair after passing out too many times.

Mrs. Rishe, who lives in Los Angeles, found a highly recommended cardiologist in the Midwest and flew there to see him. He immediately dismissed her symptoms, she said. “People who have these heart conditions aren’t this sick,” she remembers him saying. He prescribed a new heart medication, told her to exercise and sent her home.

Unsatisfied with her care, Mrs. Rishe saw yet another doctor, who ordered extensive tests that found her arteries were spasming from a lack of oxygen. “I was basically having mini-heart attacks, whenever I was having chest pain,” she said. Two months later, she had open-heart surgery to correct the problem, which she later learned may have saved her life.

“I constantly still think about how any run I went on quite literally could’ve been my last,” Mrs. Rishe said.

Research suggests that diagnostic errors occur in up to one out of every seven encounters between a doctor and patient, and that most of these mistakes are driven by the physician’s lack of knowledge. Women are more likely to be misdiagnosed than men in a variety of situations.

Patients who have felt that their symptoms were inappropriately dismissed as minor or primarily psychological by doctors are using the term “medical gaslighting” to describe their experiences and sharing their stories on sites like Instagram. The term derives from a play called “Gaslight” about a husband’s attempt to drive his wife insane. And many patients, particularly women and people of color, describe the search for accurate diagnosis and treatment as maddening.

“We know that women, and especially women of color, are often diagnosed and treated differently by doctors than men are, even when they have the same health conditions,” said Karen Lutfey Spencer, a researcher who studies medical decision-making at the University of Colorado, Denver.

Studies have shown that compared with men, women face longer waits to be diagnosed with cancer and heart disease, are treated less aggressively for traumatic brain injury, and are less likely to be offered pain medications. People of color often receive poorer quality care, too; and doctors are more likely to describe Black patients as uncooperative or non-compliant, which research suggests can affect treatment quality.

“I recall playing it over and over again in my head trying to figure out what I may have done to cause him to react this way,” said Mrs. Rishe, who is Black, about the Midwest cardiologist. “And, yes, racism crossed my mind.”

Women say doctors frequently blame their health problems on their mental health, weight or a lack of self-care, which can delay effective treatment. For instance, Dr. Spencer’s research suggests that women are twice as likely as men to be diagnosed with a mental illness when their symptoms are consistent with heart disease.

When Sarah Szczypinski, a journalist in Seattle, began experiencing knee pain and swelling in 2016 after giving birth to her son, she said that one doctor told her she had postpartum depression, while another told her she needed to lose weight and do squats — when in fact she was suffering from hip dysplasia exacerbated by her pregnancy.

She felt as though the doctors were telling her that her excruciating pain “was something that a woman needs to just live through,” she said. The condition had gotten so bad it ultimately required surgery, in 2020, to saw her leg bone in half and realign it with her hip. When she finally got the diagnosis, “I felt vindicated in a lot of ways,” she said. But ultimately, “it took three years to get a diagnosis and another two to heal.”

Women may be misdiagnosed more often than men, in part, because scientists know far less about the female body than they do about the male body, even though “there are biological differences that go down to the cellular level,” said Chloe Bird, a senior sociologist at Pardee RAND Graduate School who studies women’s health.

In 1977, the U.S. Food and Drug Administration began recommending that scientists exclude women of childbearing years from early clinical drug trials, fearing that if enrolled women became pregnant, the research could potentially harm their fetuses. Researchers were also concerned that hormonal fluctuations could muddle study results.

Today — thanks in large part to a law passed in 1993 that mandated that women and minorities be included in medical research funded by the National Institutes of Health — women are more systematically included in studies, yet there are still huge knowledge gaps.

For instance, women with heart disease often have different symptoms from men with heart disease, yet doctors are much more familiar with the male symptoms, said Dr. Jennifer Mieres, a cardiologist with Northwell Health in New York. When “women show up with symptoms that don’t fit into the algorithm we’re taught in medical school,” she said, they get “gaslit and ignored.”

By the time Michelle Cho, 32, was diagnosed with systemic lupus erythematosus, a disease in which the body slowly attacks its own tissues, she had developed kidney failure, a heart murmur and pneumonia — yet the first doctor she went to diagnosed her with allergies, she said, and the second doctor thought she was pregnant.

“I left each time feeling disappointed, sad and uneasy, because I knew they had not solved my problem or helped me in any way, and it had been yet another wasted day,” said Ms. Cho, a New York City-based medical student. “It felt like they were saying, ‘It’s all in my head.’”

When Raimey Gallant, a 42-year-old writer who lives in Winnipeg, began dropping weight, losing her hair and breaking out in a full-body rash in her 20s, she said her male doctor told her she was “young, healthy and just lazy,” when in fact, later that year she was diagnosed with Graves’ Disease, an autoimmune disorder in which the body produces too much thyroid hormone.

She also struggled for 20 years with disabling period pain before finally getting diagnosed last year with endometriosis, an inflammatory disease characterized by the presence of endometrial-like tissue outside the uterus. “I’ll never get back the pieces of life I’ve lost to medical neglect,” she said.

It’s hard to know how to begin to address these systemic problems, experts said, but scientists argue that at the very least, there needs to be more research on women’s health conditions.

Doctors should also be given more time with their patients, and see fewer patients overall, Dr. Spencer suggested. Research has shown that when people are juggling many cognitive tasks, they are more likely to make biased decisions. One study found, for instance, that male doctors were less likely to prescribe pain medications to Black patients with lower back pain when the doctors were under stress.

Physicians are often working under difficult conditions that “make it easy to make mistakes and oversights,” Dr. Spencer said. “It’s like a gauntlet of problematic systems and processes that invite bias.” Researchers have also called for more training in medical school about unconscious bias and racism in health care. In 2019, California passed a law requiring hospitals to implement implicit bias programs for all health care providers who provide perinatal care.

Until more changes occur, women and patients of color might want to consider bringing a friend or relative with them to their medical appointments, said Dr. Alyson McGregor, co-founder and director for the Sex and Gender in Emergency Medicine division at Brown University. “It really helps if you have an advocate there that can intervene and say things like, ‘She is not normally in this much pain,’” she said.

And “see another doctor if you feel dismissed,” Dr. McGregor said. You might even want to consider seeking out a woman physician or a provider with better cultural competence, who may better “understand your perspective and language.”

Four months after Mrs. Rishe’s surgery, she wrote a letter to the doctor who dismissed her symptoms. “I drafted a whole message about how that interaction left me really upset and that I felt really small,” she said. She is relieved this particular doctor is out of her life, but she worries she might have a similar experience with another physician one day.

“It’s sad,” she said, adding: “We go in on the defense and ready for it to happen, because it’s so common.”